Monday, September 14, 2020

Sexual Minorities More Likely to Experience Comorbid SUDs, Psychiatric Disorders Than Heterosexuals

Adults who identify as gay, lesbian, or bisexual with alcohol or tobacco use disorder are more likely to have another psychiatric illness than adults who identify as heterosexual, according to a report in AJP in Advance.

“[I]t is important for clinicians to know that psychiatric comorbidities are more often present than not among sexual minorities who present with an alcohol or tobacco use disorder,” wrote Rebecca Evans-Polce, Ph.D., of the University of Michigan and colleagues. “This research suggests that integrated substance use and mental health prevention and treatment programs are needed, particularly for individuals who identify as sexual minorities.”

Evans-Polce and colleagues used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions–III. As part of the survey, participants were asked questions about past-year alcohol use disorder and tobacco use disorder. The researchers analyzed data from 35,796 participants who had reported information on their sexual orientation (options included heterosexual, gay or lesbian, bisexual, or not sure) and other psychiatric conditions. Psychiatric disorders were grouped as mood disorders, anxiety disorders, or posttraumatic stress disorder (PTSD).

Among all survey respondents, 5,042 reported alcohol use disorder, and 7,188 reported tobacco use disorder in the past year. Of this group, 34.0% of adults with alcohol use disorder and 35.6% with tobacco use disorder also had a mood disorder, anxiety disorder, or PTSD. The researchers found that psychiatric comorbidities were more prevalent among members of sexual minorities; for example, 51.2% of gay or lesbian adults and 55.2% of bisexual adults who met the criteria for a past-year alcohol use disorder had a psychiatric disorder compared with 32.9% of heterosexual individuals.

Evans-Polce and colleagues also found that among members of sexual minorities, the number of stressful life events, number of adverse childhood experiences, and frequency of discrimination due to sexual orientation all contributed to the risk of comorbid psychiatric and alcohol and/or tobacco use disorders. Greater social support slightly reduced the risk of comorbid tobacco use disorder and anxiety disorders as well as comorbid tobacco use disorder and mood disorders.

“Clinicians should be cognizant of the challenges faced by sexual minorities and should consider these factors as part of their initial assessment and treatment,” Evans-Polce and colleagues wrote. “Importantly, treatment environments should be affirming of sexual minority status. Clinicians should examine their policies and practices to ensure that they are not engaging in discriminatory practices.”

For related information, see the Psychiatric Services article “Stress, Coping, and Context: Examining Substance Use Among LGBTQ Young Adults With Probable Substance Use Disorders.”

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